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Published on February 23, 2009

Unique Bypass is Rare, New Treatment for People with Severe Aortic Valve Stenosis

Previously sufferers had few options for this aggressive, deadly disease.

ABINGTON, PA (February 23, 2009) – While 77-year-old Joe Rostich of Ambler was visiting a neighbor last year, he had a sudden loss of consciousness that sent him by ambulance to Abington Memorial Hospital. Six years prior, Joe had undergone a triple coronary artery bypass and since then had been feeling well until he had recently started to experience increasing fatigue and shortness of breath.

With an echocardiogram, his cardiologist, Bruce Berger, M.D. confirmed that Joe was suffering from severe aortic valve stenosis, a narrowing of the heart valve that directs blood out of the heart. In Joe's case, his heart struggled to pump blood through an opening smaller than a drinking straw. Aortic valve stenosis is the most common acquired valvular abnormality requiring surgery and occurs most often in the elderly.

Joe was promptly referred for heart valve surgery. In Joe's case, the scar tissue that commonly results from prior surgery dramatically increased his risk for problems from conventional valve surgery. Conventional approaches for replacing the aortic valve through the breast-bone would risk serious injury to the coronary grafts which were keeping him alive. The doctors at the Porter Institute for Valvular Heart Disease had to be creative. V. Paul Addonizio, M.D., chief of Cardiac Surgery at Abington Memorial Hospital and Surgical Director of the Porter Institute recommended a procedure to bypass rather than replace the diseased aortic valve, a procedure called aortic valve bypass (AVB). This would be just the second AVB procedure performed at Abington-one of just a few centers in the nation offering this operation.

"Aortic valve bypass is a minimally invasive procedure performed through an incision between the ribs. It avoids reentering the heart through the sternum the way his original surgery was performed," says Dr. Addonizio. Unlike traditional valve surgery, during an aortic valve bypass procedure, the heart does not need to be stopped, a breastbone-splitting incision is altogether avoided, and cardiopulmonary bypass may not be necessary. Thus, aortic valve bypass can eliminate the potential risk of stroke and memory loss linked to the heart-lung machine.

"Particularly when operating on patients over 70 years of age, a gentle hand makes all the difference", says Mauricio Garrido, MD, Surgical Director of the Heart Rhythm Center at Abington Memorial Hospital and leader of the aortic valve bypass program. "This operation is consistent with our basic philosophy to be as unintrusive as possible."

During the operation, a small five-inch opening is made on the left side of the chest. Most of the heart's blood flow is diverted through a tube containing a replacement valve which is placed at the pointed tip at the bottom of the heart and connected to the aorta. The result is that blood leaving the heart can flow freely through this new connection to properly supply the entire body.

"The beauty of this procedure is that it gives high-risk patients an alternative to conventional surgery," says Nancy Bierowski, BSN, RNFA, operating room coordinator for the Heart Rhythm Center. "By bypassing the narrowed valve with tubing containing a new valve, normal blood flow can easily be restored to the body."

"This procedure is ideal for patients who have had prior cardiac surgery and are not candidates for conventional valve surgery, and for older patients who may experience side effects from having their heart stopped on the heart-lung machine," says Vicky Reynolds, CRNP, clinical coordinator for the Aortic Valve Bypass Program.

Before his surgery, Joe's continuous shortness of breath even limited his ability to work around the house. "Doctors told me my valve was ready to close," Rostich said. Statistics show that four out of five patients with untreated symptomatic aortic valve stenosis die within three years after diagnosis. "Patients are often surprised to learn that aortic valve stenosis is not unlike cancer in that it is such an aggressive deadly disease. Luckily there is a cure," says Dr. Garrido.

Joe received a careful explanation and demonstration - a "show & tell" of sorts - from his surgeons, Drs. Addonizio and Garrido. "They showed me the porcine (pig) valve and the connection tubing," said Joe. By choosing a tissue valve and not a mechanical one, Joe can live the rest of his life free of blood-thinning medications. The tubing is made from a synthetic material called Dacron and is used to create a connection from the heart to the descending aorta bypassing the patient's narrowed aortic valve. Hence the name of the procedure, aortic valve bypass.

On January 8, Rostich underwent an aortic valve bypass operation. "They went through my left side, under the ribs," he said. "They didn't have to crack open the sternum, and they avoided the scar tissue from my previous heart surgery." When it was over, "it was more of a nuisance than anything else," said Rostich. "It just felt like someone bruised me...the only thing I remember taking was a pain killer in the evening. During my stay, Drs. Addonizio, Berger and Garrido visited me every day," he said. "They paid a lot of attention to my needs."

"I would like to live a little bit longer," Rostich continued. "If I had not done anything about my valve, I wouldn't have that long to live."

"Not only will Mr. Rostich live longer but his quality of life is going to be much better," Dr. Garrido added.

The Porter Institute for Valvular Heart Disease is the first center in the area dedicated to the diagnosis and treatment of heart valve problems and is part of Abington's Pilla Heart Center. The most current published Pennsylvania Health Care Cost Containment Council (PHC4) data stated that Dr. Addonizio performed the most heart valve procedures of any surgeon in the state of Pennsylvania.

Abington Memorial Hospital is a 570-bed, acute care teaching hospital with a medical staff of more than 900 physicians and more than 5,500 employees. These professionals provide medical care and health services to an ever increasing area which includes Bucks, Montgomery and Philadelphia counties.